Abstract

Efficacy and findings of a blinded randomized reintroduction phase for the low FODMAP diet in Irritable Bowel Syndrome

Gastroenterology. 2024 Feb 22:S00165085(24)001707. doi:10.1053/j.gastro.2024.02.008.Online ahead of print.

 

K Van den Houte 1E Colomier 2K Routhiaux 1Z Mariën 1J Schol 1J Van den Bergh 3J Vanderstappen 3N Pauwels 3A Joos 3J Arts 4Ph Caenepeel 5F De Clerck 6C Matthys 7A Meulemans 7M Jones 8T Vanuytsel 9F Carbone 9J Tack 10

 
     

Author information

1Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium.

2Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

3Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.

4Department of Gastroenterology, Algemeen Ziekenhuis Sint Lucas, Brugge, Belgium.

5Department of Gastroenterology, Hospital Oost-Limburg, Genk, Belgium.

6Department of Gastroenterology, AZ Sint-Lucas, Gent, Belgium.

7Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium; Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism KU Leuven, Leuven, Belgium.

8School of Psychological Sciences, Faculty of Medicine, Health & Human Sciences, Macquarie University, NSW, Australia.

9Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium.

10Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta), KU Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospitals Leuven (UZ Leuven), Belgium. Electronic address: jan.tack@kuleuven.be.

Abstract

Background and aims: The efficacy of a low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet in Irritable Bowel Syndrome (IBS) is well established. After the elimination period, a reintroduction phase aims to identify triggers. We studied the impact of a blinded reintroduction using FODMAP-powders to objectively identify triggers and evaluated the effect on symptoms, quality of life (QoL), and psychosocial co-morbidities.

Methods: Responders to a 6-week low-FODMAP diet, defined by a drop in IBS-symptom severity score (IBS-SSS) compared to baseline, entered a 9-week blinded randomized reintroduction phase with 6 FODMAP powders (fructans, fructose, galacto-oligosaccharides, lactose, mannitol, sorbitol) or control (glucose). A rise in IBS-SSS (≥50 points) defined a FODMAP-trigger. Patients completed daily symptom diaries and questionnaires for QoL and psychosocial co-morbidities.

Results: In 117 recruited IBS patients, IBS-SSS improved significantly after the elimination period compared to baseline (150±116 vs 301±97, P < .0001, 80% responders). Symptom recurrence was triggered in 85% of the FODMAP powders, by an average of 2.5±2 FODMAPs/patient. The most prevalent triggers were fructans (56%) and mannitol (54%), followed by galacto-oligosaccharides, lactose, fructose, sorbitol, and glucose (respectively 35%, 28%, 27%, 23%, and 26%) with a significant increase in abdominal pain at day 1 for sorbitol/mannitol, day 2 for fructans/galacto-oligosaccharides and day 3 for lactose.

Conclusion: We confirmed the significant benefit of the low-FODMAP diet in tertiary care IBS. A blinded reintroduction revealed a personalized pattern of symptom recurrence, with fructans and mannitol as the most prevalent, and allows the most objective identification of individual FODMAP-triggers; Clinicaltrial.gov number: NCT04373304.

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